儿童暴发性心肌炎22例临床分析  

Clinical analysis of fulminant myocarditis in 22 children

作　　者：刘岩岩[1] 林瑶[1] 张明明[1] 石琳[1] LIU Yan-yan;LIN Yao;ZHANG Ming-ming;SHI Lin(Department of Cardiology,Children's Hospital of the Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院心血管内科,北京100020

出　　处：《中华实用诊断与治疗杂志》2023年第4期389-392,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：首都儿科研究所临床研究培育专项(LCPY-2021-09)。

摘　　要：目的探讨儿童暴发性心肌炎(fulminant myocarditis,FM)临床特点及治疗转归。方法回顾性分析22例FM患儿临床资料,包括临床表现、心肌损伤标志物、心电图、心脏超声、腹部超声检查结果及治疗转归情况等。结果22例FM患儿中3~8个月2例,1~2岁1例,3~6岁4例,7~10岁10例,12~15岁5例。起病时伴消化道症状12例,伴神经系统症状11例,伴心脏症状8例,伴呼吸道症状6例;伴精神差、面色苍白、心音低钝、末梢凉等低灌注体征16例。22例患儿均有心肌损伤标志物异常,其中肌酸激酶同工酶升高17例,肌钙蛋白T升高15例,肌钙蛋白I升高7例,脑钠肽升高17例。心电图检查示ST-T改变20例,房室传导阻滞10例,完全性右束支传导阻滞5例,完全性左束支传导阻滞2例,快速性心律失常5例(室性心动过速3例,房性心动过速2例)。13例患儿心脏超声异常,表现为心脏扩大8例,左室射血分数下降12例,心包积液4例,心室壁运动异常3例;12例起病时伴消化道症状患儿腹部超声异常10例。采用人免疫球蛋白治疗19例,大剂量糖皮质激素冲击治疗15例,足量糖皮质激素治疗4例,行临时起搏器植入治疗6例,行体外膜肺氧合治疗3例,行连续性肾脏替代治疗2例,行体外膜肺氧合联合连续行肾脏替代治疗1例,行机械通气治疗6例;好转出院20例(阿-斯综合征发作型8例,心力衰竭型10例,心动过速型2例),死亡2例(均为心动过速型),好转率为90.9%,病死率为9.1%。随访1个月时患儿左室射血分数[(68.75±6.95)%]高于治疗前[(51.35±16.71)%](t=-4.299,P<0.001);随访6个月时8例患儿仍有心电图异常,后遗症发生率为40.0%。结论FM多以心外症状起病,以消化道症状多见,同时伴有低灌注体征的学龄期儿童需高度警惕FM;心动过速型FM病死率高,心源性休克伴快速性室性心律失常时应尽早启动综合治疗以提高存活率。Institute of Pediatrics;Objective To investigate the clinical characteristics and prognosis of fulminant myocarditis(FM) in children. Methods The clinical data of 22 children with FM were retrospectively analyzed, including clinical manifestations, markers of myocardial injury, electrocardiography, echocardiography, abdominal ultrasonography and prognosis. Results In 22 children with FM, 2 were aged 3 to 8 months, 1 was aged 1 to 2 years, 4 were aged 3 to 6 years, 10 were aged 7 to 10 years and 5 were aged 12 to 15 years. At onset, 12 children had gastrointestinal symptoms, 11 had neurological symptoms, 8 had cardiac symptoms, 6 had respiratory symptoms, and 16 had hypoperfusion signs as poor spirit, pale complexion, low heart sound and cold extremities. All 22 children had myocardial injury markers abnormalities, including elevated creatine kinase isoenzyme in 17 children, elevated troponin T in 15, elevated troponin I level in 7 and elevated B-type natriuretic peptide in 17. The electrocardiography showed ST-T changes in 20 children, atrioventricular block in 10, complete right bundle branch block in 5, complete left bundle branch block in 2, and tachyarrhythmia in 5(ventricular tachycardia in 3 and atrial tachycardia in 2). In 13 children with abnormal echocardiography, heart enlargement occurred in 8, left ventricular ejection fraction decreased in 12, pericardial effusion occurred in 4 and ventricular wall movement was abnormal in 3. Ten of these 12 children with gastrointestinal symptoms at onset had abnormal abdominal ultrasound results. The treatment included administration of human immunoglobulin in 19 children, large-dose glucocorticoid shock therapy in 15, full-dose glucocorticoid therapy in 4, temporary pacemaker implantation in 6, extracorporeal membrane pulmonary oxygenation in 3, continuous renal replacement therapy in 2, extracorporeal membrane pulmonary oxygenation combined with continuous renal replacement therapy in 1, and mechanical ventilation in 6. Twenty children were discharged in good con

关 键 词：暴发性心肌炎 儿童 心源性休克 快速性室性心律失常 

分 类 号：R725.4[医药卫生—儿科]